Acute confusional states in the geriatric population

Acute confusional states in elderly persons are increasing in frequency. They represent medical emergencies with high risk of morbidity and mortality if they are not diagnosed and treated promptly and properly. Little is known about the pathophysiology of this syndrome. Differential diagnosis is broad, and because it is often not considered in its entirety, diagnostic errors occur frequently. A mnemonic is presented to assist with differential diagnosis at the bedside. Failure to perform lumbar puncture or attribution of the acute confusional state to preexisting dementia also accounts for errors in diagnosis. Treatment is based on the specific etiology of the acute confusional state. In the elderly patient, prevention can be enhanced by frequent family visits and an understanding physician. Sensory deprivation and unnecessary medication should be avoided, and sedatives and major tranquilizers should be used only with extreme care.